Monthly Archive for October, 2013

: October, 2013

By federal rules, an organization must serve at least 5,000 beneficiaries to be a Medicare ACO. Why? One reason is that the bonuses for which cost-saving ACOs would be eligible are contingent on meeting quality benchmarks. For example, there are quality targets relating to appropriate care for patients with diabetes, hypertension, coronary artery disease, etc. However, as is true for any measurement, an ACO’s quality metrics will be, statistically speaking, relatively imprecise if they are only computed for a small number of patients. The more patients, the lower the standard error of a mean value. …

Vertical restraints are agreements between firms at different stages of a production and distribution process. Vertical restraints can take many forms, as Morton reviews, one of which is the most favored nation (MFN) agreement. An example in health care comes from the case of Blue Cross Blue Shield (BCBS) of Michigan. In October 2010, the U.S. Justice Department filed suit against BCBS because the insurer required that hospitals with which it contracted charge rival insurers higher prices than they charged BCBS. This requirement favors BCBS — an example of an MFN agreement in health care. …

The American Enterprise Institute-sponsored health reform proposal offered by Jay Bhattacharya and colleagues is interesting and challenging for many reasons. One of them is the authors’ endorsement of risk rating by insurers — the antithesis of the community rating that is current practice among employer-sponsored plans and fundamental to the design of the Affordable Care Act. …

The extent to which employers will stop offering health insurance in and after 2014 is an important issue that has been a common topic of debate among academics and pundits. The Affordable Care Act’s individual mandate and exchange-coverage premium tax credits (subsidies) will go into effect in 2014. The employer mandate has been delayed until 2015. Meanwhile, it’s true now and it will remain true that employer-sponsored insurance (ESI) is exempt from taxation. …

Supporting change in the drug prohibition regime could significantly reduce drug cartel profits. As Mexico attempts to improve institutional frameworks to reduce violence, it suffers from the scourge of corruption that in turn hinders these reforms. In this sense, institutional strengthening and drug policy reform cannot be divorced. Peña Nieto has said that he is open to a debate on marijuana legalization, but that he is personally against it. Hopefully he will listen to the numerous voices of leaders in Mexico — such as former President Vicente Fox and Ernesto Zedillo — who are calling for graduated drug policy reforms in Mexico, including decriminalization policies. …

The Affordable Care Act — Obamacare — was never my idea of the perfect health care reform package, but after it passed into law, I got on board because it offered the opportunity to put a brake on the trajectory of decreasing access to increasingly expensive health care and health insurance. …

For more than a decade, parties interested in the problem of computer, information or cyber security have warned of a digital doomsday, the electronic Pearl Harbor event. The general prognostication around such event, most recently invoked at the highest levels of the U.S. government at a speech by departing defense secretary Leon Panetta last year, is that society should be concerned by mass disruption of the communications infrastructure and all of the other infrastructure pieces connected to it. If Pearl Harbor was the greatest intelligence failure in U.S. history, then allow us to offer that the Snowden leaks are the greatest intelligence failure our country has seen in the digital age. …

According to statistics from Mexican government agencies, at least 135,000 people have been murdered since 2007, and more than 25,000 have disappeared. By the Mexican government’s own admission, it is not possible to distinguish “drug-related” homicides from other killings. President Enrique Peña Nieto took office on Dec. 1, 2012, and pledged to bring peace. His administration claims a significant decline in homicides, but presents no evidence to support that claim. …

Brutal murders, beheadings, and assaults on police and the media punctuate news reports from Mexico on a near daily basis — that is, the reports that make it to the U.S. While the common perception is that insecurity is high, official accounts downplay the extent and impact of the violence. Indeed, many media outlets still quote a death toll of 60,000 to 70,000 since the drug war began in 2006. This is both inaccurate and disingenuous. …

While it has been suggested that drug violence may be somewhat tempered in Mexico with the quieting of the Ciudad Juárez and Tijuana plazas, overall criminality has risen. This means that violence in Mexico has metastasized within the country, just as the cartels and gangs have branched out into numerous other illicit activities. …

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